Legal claims defining the scope of protection, as filed with the USPTO.
1. A method implemented on a computer system of determining physician efficiency, the method comprising: obtaining medical claims data stored on a computer readable medium accessible by the computer system; performing patient analysis using said obtained medical claims data to form episodes of care utilizing the computer system; performing an output process based on the performed patient analysis utilizing the computer system, the output process comprising: assigning episodes of care to physicians; and applying a first maximum duration rule to identify episodes of care; assigning at least one physician to a report group utilizing the computer system; determining eligible physicians and episode of care assignments utilizing the computer system; calculating condition-specific episode of care statistics utilizing the computer system; calculating, using indirect standardization, weighted episode of care statistics across medical conditions utilizing a predefined set of medical conditions for a specific specialty type utilizing the computer system; and determining efficiency scores for physicians from said calculated condition-specific episode of care statistics and said weighted episode of care statistics calculated across medical conditions utilizing the computer system.
2. The method of claim 1 , wherein said act of calculating weighted episode of care statistics further comprises calculating peer group weighted episode of care statistics across medical conditions utilizing indirect standardization.
3. The method of claim 1 , wherein said act of calculating weighted episode of care statistics further comprises calculating physician weighted episode of care statistics across medical conditions utilizing indirect standardization.
4. A computer program product tangibly embodied in computer instructions in a computer readable medium which, when the computer instructions are executed by a computer system, determines physician efficiency, by performing the acts of: obtaining medical claims data stored on a computer readable medium accessible by the computer system; performing patient analysis using said obtained medical claims data to form episodes of care utilizing the computer system; performing an output process based on the performed patient analysis utilizing the computer system, the output process comprising: assigning episodes of care to physicians; and applying a first maximum duration rule to identify episodes of care; assigning at least one physician to a report group utilizing the computer system; determining eligible physicians and episode of care assignments utilizing the computer system; calculating condition-specific episode of care statistics utilizing the computer system; calculating, using indirect standardization, weighted episode of care statistics across medical conditions utilizing a predefined set of medical conditions for a specific specialty type utilizing the computer system; and determining efficiency scores for physicians from said calculated condition-specific episode of care statistics and said weighted episode of care statistics calculated across medical conditions utilizing the computer system.
5. The computer program product of claim 4 , wherein said act of calculating weighted episode of care statistics further comprises calculating peer group weighted episode of care statistics across medical conditions utilizing indirect standardization.
6. The computer program product of claim 4 , wherein said act of calculating weighted episode of care statistics comprises calculating physician weighted episode of care statistics across medical conditions utilizing indirect standardization.
7. A computer system for determining physician efficiency, the computer system comprising at least one processor in communication with at least one memory device, the processor programmed to: obtain medical claims data stored on a computer readable medium accessible by the computer system; perform patient analysis using said obtained medical claims data to form episodes of care; perform an output process based on the performed patient analysis, the output process comprising: assigning episodes of care to physicians; and applying a first maximum duration rule to identify episodes of care; assign at least one physician to a report group; determine eligible physicians and episode of care assignments; calculate condition-specific episode of care statistics; calculate, using indirect standardization, weighted episode of care statistics across medical conditions utilizing a predefined set of medical conditions for a specific specialty type; and determine efficiency scores for physicians from said calculated condition-specific episode of care statistics and said weighted episode of care statistics calculated across medical conditions.
8. The system of claim 7 , wherein said processor is further programmed to calculate weighted episode of care statistics by calculating peer group weighted episode of care statistics across medical conditions utilizing indirect standardization.
9. The system of claim 7 , wherein said processor is further programmed to calculate weighted episode of care statistics by calculating physician weighted episode of care statistics across medical conditions utilizing indirect standardization.
10. A computer-implemented method for determining physician efficiency, the computer including at least one processor in communication with a memory, the method comprising: retrieving, by the at least one processor, medical claims data stored on the memory; performing, by the at least one processor, patient analysis using said retrieved medical claims data to form episodes of care; performing, by the at least one processor, an output process based on the performed patient analysis, the output process comprising: assigning episodes of care to physicians; and applying a first maximum duration rule to identify episodes of care; assigning, by the at least one processor, at least one physician to a report group; determining, by the at least one processor, eligible physicians and episode of care assignments; calculating, by the at least one processor, condition-specific episode of care statistics; calculating, by the at least one processor, weighted episode of care statistics across medical conditions utilizing a predefined set of medical conditions for a specific specialty type and predefined weight factors, wherein each weight factor represents an importance of the respective medical condition to the specific specialty type; and determining, by the at least one processor, efficiency scores for physicians from said calculated condition-specific episode of care statistics and said weighted episode of care statistics calculated across medical conditions.
11. The computer-implemented method of claim 10 , wherein a sum of the predefined weight factors for the predefined set of medical conditions equals 1.0.
12. The computer-implemented method of claim 11 , wherein the predefined weight factors are used to calculate an overall weighted mean and standard deviation across all medical conditions of the predefined set of medical conditions.
13. The computer-implemented method of claim 10 , wherein calculating the weighted episode of care statistics further comprises calculating, by the at least one processor, peer group weighted episode of care statistics across medical conditions.
14. The computer-implemented method of claim 10 , wherein calculating the weighted episode of care statistics further comprises calculating physician weighted episode of care statistics across medical conditions.
15. Non-transitory computer-readable storage media having computer-executable instructions embodied thereon, wherein, when executed by at least one processor, the computer-executable instructions cause the at least one processor to: retrieve medical claims data stored on a memory; perform patient analysis using said retrieved medical claims data to form episodes of care; perform an output process based on the performed patient analysis, the output process comprising: assigning episodes of care to physicians; and applying a first maximum duration rule to identify episodes of care; assign at least one physician to a report group; determine eligible physicians and episode of care assignments; calculate condition-specific episode of care statistics; calculate weighted episode of care statistics across medical conditions utilizing a predefined set of medical conditions for a specific specialty type and predefined weight factors, wherein each weight factor represents an importance of the respective medical condition to the specific specialty type; and determine efficiency scores for physicians from said calculated condition-specific episode of care statistics and said weighted episode of care statistics calculated across medical conditions.
16. The non-transitory computer-readable storage media of claim 15 , wherein a sum of the predefined weight factors for the predefined set of medical conditions equals 1.0.
17. The non-transitory computer-readable storage media of claim 16 , wherein the predefined weight factors are used to calculate an overall weighted mean and standard deviation across all medical conditions of the predefined set of medical conditions.
18. The non-transitory computer-readable storage media of claim 15 , wherein the computer-executable instructions further cause the at least one processor to calculate the weighted episode of care statistics by calculating peer group weighted episode of care statistics across medical conditions.
19. The non-transitory computer-readable storage media of claim 15 , wherein the computer-executable instructions further cause the at least one processor to calculate the weighted episode of care statistics by calculating physician weighted episode of care statistics across medical conditions.
20. A computer system for determining physician efficiency, the computer system comprising at least one processor in communication with at least one memory device, the at least one processor programmed to: retrieve medical claims data stored on the at least one memory device; perform patient analysis using said retrieved medical claims data to form episodes of care; perform an output process based on the performed patient analysis, the output process comprising: assigning episodes of care to physicians; and applying a first maximum duration rule to identify episodes of care; assign at least one physician to a report group; determine eligible physicians and episode of care assignments; calculate condition-specific episode of care statistics; calculate weighted episode of care statistics across medical conditions utilizing a predefined set of medical conditions for a specific specialty type and predefined weight factors, wherein each weight factor represents an importance of the respective medical condition to the specific specialty type; and determine efficiency scores for physicians from said calculated condition-specific episode of care statistics and said weighted episode of care statistics calculated across medical conditions.
21. The computer system of claim 20 , wherein a sum of the predefined weight factors for the predefined set of medical conditions equals 1.0.
22. The computer system of claim 21 , wherein the predefined weight factors are used to calculate an overall weighted mean and standard deviation across all medical conditions of the predefined set of medical conditions.
23. The computer system of claim 20 , wherein the at least one processor is further programmed to calculate the weighted episode of care statistics by calculating peer group weighted episode of care statistics across medical conditions.
24. The computer system of claim 20 , wherein the at least one processor is further programmed to calculate the weighted episode of care statistics by calculating physician weighted episode of care statistics across medical conditions.
25. Non-transitory computer-readable storage media having computer-executable instructions embodied thereon, wherein, when executed by at least one processor, the computer-executable instructions cause the at least one processor to: retrieve medical claims data stored on a memory; perform patient analysis using said retrieved medical claims data to form episodes of care; perform an output process based on the performed patient analysis, the output process comprising: assigning episodes of care to physicians; and applying a first maximum duration rule to identify episodes of care; assign at least one physician to a report group; determine eligible physicians and episode of care assignments; calculate condition-specific episode of care statistics; calculate weighted episode of care statistics across medical conditions utilizing a predefined set of medical conditions for a specific specialty type and composition-based weight factors, wherein the composition-based weight factors are based on a proportion of the episodes of care associated with each of the medical conditions in the predefined set; and determine efficiency scores for physicians from said calculated condition-specific episode of care statistics and said weighted episode of care statistics calculated across medical conditions.
26. The non-transitory computer-readable storage media of claim 25 , wherein a sum of the composition-based weight factors for the predefined set of medical conditions equals 1.0.
27. The non-transitory computer-readable storage media of claim 26 , wherein the composition-based weight factors are used to calculate an overall weighted mean and standard deviation across all medical conditions of the predefined set of medical conditions.
28. The non-transitory computer-readable storage media of claim 25 , wherein the computer-executable instructions further cause the at least one processor to calculate the weighted episode of care statistics by calculating peer group weighted episode of care statistics across medical conditions using the composition-based weight factors that are based on the proportion of the episodes of care associated with each of the medical conditions in the predefined set across the report group.
29. The non-transitory computer-readable storage media of claim 25 , wherein the computer-executable instructions further cause the at least one processor to calculate the weighted episode of care statistics by calculating physician weighted episode of care statistics across medical conditions using the composition-based weight factors that are based on the proportion of the episodes of care associated with each of the medical conditions in the predefined set for the physician.
30. The non-transitory computer-readable storage media of claim 25 , wherein the composition-based weight factor for each of the medical conditions is based on a number of the episodes of care associated with the medical condition divided by a total number of episodes of care across the predefined set.
31. A computer system for determining physician efficiency, the computer system comprising at least one processor in communication with at least one memory device, the at least one processor programmed to: retrieve medical claims data stored on the at least one memory device; perform patient analysis using said retrieved medical claims data to form episodes of care; perform an output process based on the performed patient analysis, the output process comprising: assigning episodes of care to physicians; and applying a first maximum duration rule to identify episodes of care; assign at least one physician to a report group; determine eligible physicians and episode of care assignments; calculate condition-specific episode of care statistics; calculate weighted episode of care statistics across medical conditions utilizing a predefined set of medical conditions for a specific specialty type and composition-based weight factors, wherein the composition-based weight factors are based on a proportion of the episodes of care associated with each of the medical conditions in the predefined set; and determine efficiency scores for physicians from said calculated condition-specific episode of care statistics and said weighted episode of care statistics calculated across medical conditions.
32. The computer system of claim 31 , wherein a sum of the composition-based weight factors for the predefined set of medical conditions equals 1.0.
33. The computer system of claim 32 , wherein the composition-based weight factors are used to calculate an overall weighted mean and standard deviation across all medical conditions of the predefined set of medical conditions.
34. The computer system of claim 31 , wherein the at least one processor is further programmed to calculate the weighted episode of care statistics by calculating peer group weighted episode of care statistics across medical conditions using the composition-based weight factors that are based on the proportion of the episodes of care associated with each of the medical conditions in the predefined set across the report group.
35. The computer system of claim 31 , wherein the at least one processor is further programmed to calculate the weighted episode of care statistics by calculating physician weighted episode of care statistics across medical conditions using the composition-based weight factors that are based on the proportion of the episodes of care associated with each of the medical conditions in the predefined set for the physician.
36. The computer system of claim 31 , wherein the composition-based weight factor for each of the medical conditions is based on a number of the episodes of care associated with the medical condition divided by a total number of episodes of care across the predefined set.
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July 20, 2021
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